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Lymphangectasia in a dog

Species: Dog
Breed: golden
Age: 1-2 years
Hi Dr,

Sorry to bother you again.

Max's biopsies came back. strong possibility of lmphagectasia.

No hypoalbumenemia present (as yet). Leuko is also within range, no villus atrophy, no fibrosis.

DIOGNOSIS from PATH "in some small intestine biopsies substantial dilation of villus lacteals in the abscence of any other histologic changes... suggest lymphagectasia"



Before finalizing they want to 1) fecal alpha 1 protease 2) fasting TLI and 3) another biopsy as the colon tissue wasn't processed.

I remember hearing about this from my last dog. It sounded really bad.

What has been your experiences with this desease (assuming the fecal test is positive) ?

Thanks again.


Online vet, Dr. Marie

Dr. Marie replied:

Oh man Jay. I was not expecting lyphangectasia. This is not good news. It has been years since I have had a confirmed case of lymphangectasia and I remember that it was not good.

I am not able to research right now but in the next couple of hours I will get some good information for you. Sorry for the delay but I want you to get the right information.



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Online vet, Dr. Marie

Dr. Marie replied:

Sorry for the delay. It looks like my previous reply did go through after all. Every now and then I have problems when I am trying to access my site with my phone. I'll soon be getting an iphone (when the iphone 5 comes out) so this should make things better.

So, let's see if I can help you understand the report better.

First of all, lymphangectasia means that the lymph vessels in the intestines are dilated. This condition is usually caused by inflammation in the intestines. It can be a genetic condition where a dog is born with improperly working lymphatics. (If this is the case then often we don't see symptoms until 2-5 years of age.)

Max's problem is probably because of inflammation but the problem with Max is that we don't know what the cause of inflammation is. One of the more common causes is inflammatory bowel disease. However, it's a little strange that this was not mentioned on the biopsy. It sounds like they weren't happy with the quality of their biopsies and this is why they want to go back and do another one. This is frustrating but I've seen it happen quite often. I think the second biopsy is important because we need to know if this is primarily inflammatory bowel disease.

When the lymph vessels get filled up like this then there is a risk that protein is going to start to leak out of the intestines. This can be serious. This is why they have suggested doing the alpha 1 protease inhibitor test. This test looks at multiple fecal samples to determine if there is protein loss in the stool. It is a complicated test for the lab to run. The last time I did one (which was about 4 years ago) there was only one lab (I believe in Michigan) that did the test. But, it is quite accurate.

If Max has PLE (protein losing enteropathy) then this is not good. There are things that can be done to help, but some dogs can get sick enough that they do not survive the disease.

There are some dogs that are genetically predisposed to PLE, but Golden Retrievers are not on this list.

The good is, however, that there are no obvious signs of protein loss in Max. "No hypoalbuminemia" means that he is not low on albumin. Albumin is the protein that is usually lost into the intestines. So, if a dog is really sick with PLE then we will see low albumin levels. Your vet may periodically want to check his albumin in the future to see where it is at.

Most dogs with lymphangectasia will have a low lymphocyte level. Lymphocytes are the cells that make up the bulk of the lymph fluid and if they were all rushing to the intestines then his blood level should be low. It is a good sign that his level is normal.

Sometimes lymphangectasia can be caused by a heart problem, but Max's recent ultrasound rules this out for us.

I believe it is possible for the lymph vessels to look full if Max had not been properly fasted before his biopsy.

So, to summarize, if there is lymphangectasia it could be there because of genetic reasons, or because of a condition causing inflammation in the bowels. That inflammation could be IBD or PLE (or possibly other causes). The repeat biopsy will hopefully tell us if there is IBD there. If so, then this can be treated. The alpha-1 inhibitor test should tell us if there is protein loss into the intestines indicating PLE. If this is the case then there are things that can be done to help, but it can get much worse and can be fatal. (I really am doubtful that this is PLE). It's also possible that the finding of dilated lymphatics was because of a recent meal if he wasn't fasted properly.

I hope that helps you to understand more. It's going to be hard to wait while we go through the next bout of tests.

Dr. Marie.





Customer reply:

Thank you for clearing that up.
The specialist said in his experience, even the most severe lymphagectasia cases have a good chance of bring brought back (mind, thats with tranfusions) to a stable state.

The thought of a wasting desease is petrifying.


My best hope is there is no protein loss and just some IBD.

I've started him on Medical GI Low Fat (coincidentally I just threw out a bag since he vomited on it before).

Fingers crossed.



Online vet, Dr. Marie

Dr. Marie replied:

I'll be really surprised if this turns out to be something serious. But it wouldn't surprise me if there was some mild IBD and this caused the lymphagectasia. If this is the case then getting the IBD treated properly will solve the problem.



Online vet, Dr. Marie

Dr. Marie replied:

Thanks for sending me the report.

I can tell by the tone and style of the pathologist report that this is from the same pathologist that I use in my clinic. He is an incredibly intelligent man!

From reading the report it really does sound like the potential lymphangectasia is unlikely. There really should be evidence of IBD or protein loss or a decreased lymphocyte count in order to make the call. I think the plan is a good one - start back on the Medical GI Low Fat (I agree that this is a great food), do the alpha-1 inhibitor test and if necessary repeat the biopsies.



Customer reply:

But if the potential lymphagectasia is low, why are the villus lacteals so dilated?

Perhaps an early stage of it, prior to loss of albumen (which requires 80% colonic damage)
If the fecal protein tests are positive I have to accept it in the abscence of other evidence.



Online vet, Dr. Marie

Dr. Marie replied:

My answer here is purely speculation as I really don't have much experience with dilated lacteals. Is it possible that Max had any food within 12 hours of his biopsies? If so, this could possibly cause it.

Or, it's possible that any inflammation from IBD could cause some temporary lymphangectasia. If this is the case, then controlling the IBD will control the lymphangectasia. Not sure though!



Customer reply:

I'm not sure myself.
The vet has been practicisng for over 40 years and he said he was pretty sure it was lymphagectasia but needs to find out if there's anything else.

I will keep you posted.



Online vet, Dr. Marie

Dr. Marie replied:

Thanks Jay. Keep me posted.

I have to tell you again that I'm no expert on lymphangectasia. Your vet is definitely going to be the best source of information for you but if you need clarification along the way I'll do my best to help.



Customer reply:

thanks. If I hear anything insightful I will pass it one.



Customer reply:

Switching to GI Low Fat has helped his stools a lot. Just waiting on the pancreatic, biopsy and stool alpha protein tests now.

I thought you might find this funny knowing Max.

It's Tuesday. He's already had his biopsy and by 7 pm he's awake enough to come home. As I'm leaving the house the clinic calls to tell me there's an "update" on his condition - he's swallowed the tensor bandage while in his cage!

When I get there he's brought up about 6 feet of blue tensor bandage from the apomorphine. I stay with him another hour until he can come home.

Thank God there's no signs of blockage - normal appetite/stools, activity levels high, no vomiting.

There's a Thanksgiving for you.

Have a great Thanksgiving!




Online vet, Dr. Marie

Dr. Marie replied:

Glad to hear that the Low Fat food is helping!

Max is too funny. That dog will keep you entertained for years. :)

You have a great Thanksgiving as well!

Dr. Marie.



Customer reply:

Hi Dr,

Just in case you ever have another patient like Max (as if)...

Though the biopsy showed dilated lymph tubules, there was no indication of elevated TLI, IBD or elevated Alpha 1 proteins (which were actually 3.5 [2.2-18.7]).

Internist recommends maintaining low fat diet and retesting in 6 months. Prognosis good. Tubules expected to heal. Eventually transition to normal diet. Max may be less able to cope with high fatty foods that normal dogs.

Would you believe 7 days after swallowing the co-flex, he threw up the remaining 3 feet of it!

Thanks for your help

Jay



Online vet, Dr. Marie

Dr. Marie replied:

There could never be another Max. :) But, thanks for the update. I can't believe he just threw up 3 feet of bandage material! Glad to hear that Max is doing well!

Marie



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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